VEER SURENDRA SAI UNIVERSITY OF TECHNOLOGY :

(Formerly University College BURLA

of Engg., Burla-Established by Govt. of
Odisha in 1956 &
Upgraded in 2009 to A State Govt. University covered under Section 2(f) & 12(B) of UGC
Act.)
P.O: Engineering
E-mail: College, Burla
registrar@vssut.ac.in,Phone : (0663)(Siddhi Vihar), :Dist:
2430 573/211,Fax (0663)Sambalpur
2430 592/204,
mail: registrar@vssut.ac.in,PhoneOdisha 768018,
: (0663) 2430 India
573/211,Fax : (0663) 2430 592/204,

FORMAT FOR APPLYING FOR PASSPORT

(For Students)

1. Name : SURYA NARAYAN SATAPATHY

2. Regd. No. : 14010720

3. Semester : 6th SEM

4. Branch : MECHANICAL

5. Address : C/O-RADHA MOHAN SATAPATHY

SARIA BHAWAN, STADIUM ROAD,PUJARIPUT
KORAPUT, PIN-764020
ODISHA
6. Mobile No. : 7205512990

7. E-mail ID : suryanarayansatapathy1996@gmail.com

[Signature of Student] [HOD]